High court briefed on health impact of same-sex marriage ruling

U.S. Supreme Court justices will hear arguments March 26 and 27 in two major cases on whether same-sex couples should have the legal right to marry, a question that some physician organizations said is not only a social one, but also a medical one.

In United States v. Windsor, the high court will weigh whether the Defense of Marriage Act, signed into law by President Clinton in 1996, violates the equal protection rights of same-sex couples. DOMA prevents the federal government from recognizing marriages between gay and lesbian couples for the purposes of federal laws or programs, even if couples are considered legally married in their home states.

In Hollingsworth v. Perry, justices will consider whether a 2008 voter-backed initiative in California banning same-sex marriage is constitutional.

Physician organizations, including the American Medical Association, filed briefs with the high court urging justices to uphold appellate decisions finding DOMA and the California ban unconstitutional. Denying same-sex couples the right to marry is detrimental to the couples’ health and the health of their children, the associations said.

Preventing such civil marriage “contributes to poorer health outcomes for gay and lesbian individuals, couples and their families,” said Paul R. Phinney, MD, president of the California Medical Assn., which joined the AMA’s friend-of-the-court brief on the state case. The CMA and physician leaders support “efforts to reduce health care disparities among members of same-sex households, including measures to afford such households equal rights and privileges to health care, health insurance and survivor benefits.”

Conservatives defend “traditional” model

In the DOMA case, Edith Windsor sued the federal government after she was denied a spousal deduction on her federal estate taxes after her female spouse died. She and her partner were married in Canada in 2007 and were residents of New York, which now also permits same-sex marriage. But under DOMA, the federal government refused to recognize the same-sex couple as married for the purposes of calculating the federal estate tax.

Because the Obama administration did not act to defend DOMA in the case, the Bipartisan Legal Advisory Group intervened to defend the federal law. BLAG is a five-member legislative panel consisting of the speaker of the House and other congressional leaders. They argued that DOMA does not override or invalidate any state’s decision to modify the definition of marriage, but that it preserves the federal government’s ability to use the traditional definition of marriage for federal law and programs. Lower courts, including the 2nd U.S. Circuit Court of Appeals, ruled in favor of the plaintiffs. Messages seeking comment from the Dept. of Justice, Windsor’s attorney and House Speaker John Boehner (R, Ohio) were not returned.

California voters enacted the state’s same-sex marriage ban in November 2008. Proposition 8 amended the state constitution to eliminate the rights of same-sex couples to marry. Two same-sex couples sued the state over the ban. California declined to defend the law, and a district court granted a group of voters — led by then California State Sen. Dennis Hollingsworth — the right to intervene as defendants. The 9th U.S. Circuit Court of Appeals ruled in favor of the couples in 2012.

In a statement, Alliance Defending Freedom, a Christian organization representing the defendants, said marriage between men and women benefits society, which is why marriage policy is rooted in the reality “that children need a mother and a father.”

“Marriage between a man and a woman is a universal good that diverse cultures and faiths have honored throughout the history of Western civilization,” said ADF attorney Jim Campbell. “Marriage expresses the truth that men and women bring distinct, irreplaceable gifts to family life. [Our] legal team looks forward to advocating before the U.S. Supreme Court on behalf of the people’s right to preserve this fundamental building block of civilization.”

Emphasis on commitment, not gender

Opponents of gay marriage have no medical science to back up their claims that such unions are harmful to children and society, said Jack Drescher, MD, a psychiatrist and member of the American Psychiatric Assn.’s DSM-5 Sexual and Gender Identity Disorders Work Group.

“What the science shows is that children raised by two parents do better than children raised by one parent, but the science does not show how well children do based on the gender of the parents,” he said. “The idea that somehow these children aren’t doing as well has not been borne out by the literature.”

The AMA’s brief in the DOMA case was joined by the American Psychological Assn. and the American Psychiatric Assn., among others. It stated that when parent-child relationships are characterized by affection, emotional commitment, reliability, consistency and appropriate guidance, children are likely to show more positive adjustment than when these qualities are absent.

“Children whose parents provide loving guidance in the context of secure home environments are more likely to flourish, regardless of their parents’ sexual orientation,” the brief said. “DOMA is an instance of institutional stigma. It conveys the government’s judgment that, in the realm of intimate relationships, a legally married same-sex couple is inherently less deserving of society’s full recognition through the provision of federal marriage-linked benefits than are heterosexual couples. By devaluing and delegitimizing the relationships that constitute the very core of a homosexual orientation, the act compounds and perpetuates the stigma historically attached to homosexuality.”

Dr. Drescher added that in general, marriage has been shown to have positive mental health impacts on couples. Conversely, research has shown that lesbian, gay, bisexual and transgender residents of states where same-sex bans are in place have increased levels of anxiety and stress.

“People in stable, long-term relationships have better health and mental health outcomes,” he said. “The denial of this right can interfere with people’s health.”

On March 20, the American Academy of Pediatrics officially announced that it was supporting civil marriage rights for all couples, stating that the evidence shows children benefit emotionally and developmentally from being raised by two committed parents regardless of gender. “If a child has two living and capable parents who choose to create a permanent bond by way of civil marriage, it is in the best interests of their child(ren) that legal and social institutions allow and support them to do so, irrespective of their sexual orientation,” the academy said in a policy statement in the journal Pediatrics.

Rulings in the DOMA and California cases will have a significant impact on the rights of same-sex couples and their families across the nation, said Hector Vargas, executive director of the Gay and Lesbian Medical Assn., now called Health Professionals Advancing LGBT Equality. GLMA issued a friend-of-the-court brief in support of the same-sex couples in both cases.

“What these cases are really about is whether or not lesbian and gay Americans should have the same freedoms as everybody else,” he said. “This will be the first time that the Supreme Court will actually hear the various issues around marriage equality for gay and lesbian Americans.”

The fact so many physician leaders have reached out to support the plaintiffs and explain the science behind same-sex marriage speaks volumes, he said.

“It’s pretty significant in terms of how we achieve equality for LGBT people,” he said. “It sends a very important message that obviously we are talking about discrimination and fairness, but we’re also talking about the health and well-being of LGBT Americans.”